4 July 2019
Tameside and Glossop Integrated Care NHS Foundation Trust is an integrated acute and community trust based in the borough of Tameside, which is part of Greater Manchester, in North West England. The trust transitioned to an integrated trust in September 2016.
The trust has one acute hospital which is Tameside General Hospital. The trust delivers acute and community services across Tameside and Glossop in Derbyshire.
Tameside and Glossop Integrated Care NHS Foundation Trust serves a population of 250,000 living over an area of around 40 square miles, across both rural and urban settings. The trust employs about 3,800 staff, has 524 beds across 28 wards and departments, 300 volunteers and has an annual turnover of £215 million.
The trust also provides community healthcare services across five neighbourhoods in Tameside and Glossop. These are delivered in community locations and in people’s homes, throughout the locality. This includes the Stamford Unit which is a 96 bed community facility to support patients who are determined to be medically fit for discharge. These are patients requiring further support in a non-acute setting to be assessed and discharged into their normal place of residence.
Services are predominantly commissioned by Tameside clinical commissioning group and Metropolitan Borough Council which combined to become one organisation.
Nationally, Tameside is 34th out of 326 most deprived local authority. It has the highest premature death rate for heart disease in England. In adults, the recorded diabetes prevalence, excess weight and drug and alcohol misuse are significantly worse than the England average. Rates of smoking related deaths and hospital admissions for alcohol harm are significantly higher than the England average. Healthy life expectancy for males is 57.7 years compared with the national average of 63.4 years; for women the healthy life expectancy is 58.3 years against a national average of 64 years.
The population is predominantly white British (91%).
The trust has been inspected previously. It was rated as inadequate in 2014, requires improvement in 2015 and, at the last inspection in 2016, was rated as good.
Community services were not part of the trust at the last inspection. The trust acquired community services in 2016. They have not previously been inspected under this provider.
4 July 2019
Our rating of the trust stayed the same. We rated it as good because:
- We rated safe, effective, caring, responsive and well-led as good. We rated eleven of the trust’s 12 services as good and one as outstanding. In rating the trust, we took into account the current ratings of the six services not inspected this time.
- We rated well-led for the trust overall as good.
- Since our last inspection, there had been improvement in the completion of mandatory training across the trust and the concerns raised within maternity services had been addressed.
- There were enough staff with the right qualifications, competence, skill and experience, in most areas, to deliver care and treatment to meet patient’s needs.
- Effective systems were in place to protect patients from abuse, manage patient risk and safety incidents and provide evidence-based care.
- The trust controlled infection risk well. Equipment and premises were kept clean in most areas and there were systems and processes in place to prevent the spread of infection.
- Staff cared for patients with compassion. Feedback from patients and most carers confirmed that staff treated them well and with kindness.
- There had been significant work undertaken to prevent admission to hospital, support people in their homes and improve access and flow across the trust. There were demonstrable reductions in length of stay, a reduction in patient cancellations, reduction in long stay beds and evidence of admission avoidance.
- Leaders were experienced and had the capability to make sure that a quality service was delivered and risks to performance were addressed. The executive and service level teams were delivering good operational performance as well as being focused on the development of the local integrated care system. There was evidence of compassionate, inclusive and effective leadership across the organisation.
- There were not enough children’s nurses and emergency paediatric consultants to deliver a consistent 24-hour paediatric emergency care service in line with national guidance (DH Facing the Future).
- Within the Stamford Unit delivering community inpatient services, the therapy service was limited to five days a week; therapy staff did not feel they were able to offer rehabilitation as much as they wanted to.
4 July 2019
This service has not previously been inspected. We rated it as outstanding because:
- There were innovative approaches to providing integrated person-centred pathways of care that involve other service providers, particularly for people with multiple and complex needs. This enabled patients’ needs to be met in the community setting, and wherever possible avoided the need for admission to hospital.
- The service planned and provided services in a way that met the needs of local people. Services were tailored to meet the needs of individual people and were delivered in a way to ensure flexibility, choice and continuity of care.
- The service monitored the effectiveness of care and treatment and used the findings to improve them. Outcomes for people who use services were routinely monitored, were positive and some exceeded expectations.
- People could access community health services when they needed them. We saw that waiting times to access services were significantly better than all national targets and most locally set targets.
- Staff were consistent in supporting people to live healthier lives, including identifying those who need extra support, through a targeted and proactive approach to health promotion and prevention of ill-health, and they used every contact with people to do so.
- There was compassionate, inclusive and effective leadership at all levels. Leaders at all levels demonstrate the high levels of experience, capacity and capability needed to deliver excellent and sustainable care. All managers had a deep understanding of issues, challenges and priorities in their service.
- There was strong collaboration, team-working and support across all functions and a common focus on improving the quality and sustainability of care and people’s experiences.
- The trust used a systematic approach to continually improving the quality of its services, safeguarding high standards of care and worked with other organisations to improve care outcomes.
- Services were developed with the full participation of those who use them, staff and external partners as equal partners. Innovative approaches were used to gather feedback from people who use services and the public.
- The service made sure staff were competent for their roles, had received mandatory training and received their appraisal.
- The service had effective systems and processes in place to protect patients from abuse, assess, control infection risk and respond to patient risk.
- The service had received a low number of complaints. Staff knew how to deal with complaints and concerns and complaints were acknowledged, investigated and responded to in an appropriate and timely way.
- The risk register did not always provide documentary evidence risks had been reviewed.
- Staff did not have access to pictorial aids to assist when caring for a patient with additional needs.
- Not all staff had the recommended equipment to use when assessing a patient for sepsis.
4 July 2019
We had not previously rated this service. We rated it as good because:
- Community services for children, young people and families directorate provided staff with training in safety systems, processes and practices and staff had a high level of compliance in training. Training was monitored by local managers and by the trust and was conducted on induction and on a regular basis.
- The trust had an in-date safeguarding policy and training modules which were available to all teams in the directorate. Staff had a high level of compliance with training and staff we talked to in the directorate knew the policy existed and knew how to apply it to protect children and families.
- The trust had an infection prevention and control policy and training module, which was available to all teams in the directorate. Training rates were high and audits with good outcomes were undertaken by staff to ensure compliance.
- The directorate reported no incidents classified as never events and no serious incidents in the period to December 2018. Incidents were reviewed and monitored.
- The directorate used evidence based policies and national guidelines across its services, these included guidance from the Department of Health and the National Institute for Health and Care Excellence.
- Staff in the directorate understood the relevant consent and decision-making requirements of legislation and how this related to young people such as guidance for Mental Capacity Act 2005, Children’s Acts 1989 and 2004, Gillick competence 1985.
- Staff of all professions in the directorate acted with compassion and respect towards the patients and families. We observed staff talking to patients and carers continually about what was happening and providing re assurance.
- Staff teams understood and met the needs of local people and had introduced systems so that staff deployment met the need of high and low population areas.
- The staff in the directorate were aware of the diversity of populations and the challenges faced by some of its communities. Staff had access to multi-lingual sources such as translation services to support patient care.
- The directorates leaders had the skills, knowledge and experience to guide and lead staff. management were respected, seen as supportive and effective in their roles.
- Leaders in the trust and in the directorate had a vison for children and families’ services which focused on promoting well-being and nurturing. The service planned to move to a more holistic model of care which was connective with other services to promote well-being.
4 July 2019
We had not rated this service before. We rated it as good because:
- The service provided mandatory training in key skills to all staff and made sure everyone completed it.
- Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
- The service controlled infection risk well. Staff kept equipment and the premises clean. They used control measures to prevent the spread of infection.
- The service had suitable premises and equipment and looked after them well.
- Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.
- The service had enough nursing staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
- The service had enough medical staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
- Staff kept detailed records of patient’s care and treatment and the records were completed and managed appropriately.
- The service has systems in place that ensured that medicines were administered and stored safely. Patients received the medicines they were prescribed in a safe manner.
- The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
- The service monitored safety using information from a range of sources. The information was monitored over a period, to feed into service improvement.
- Patients care and treatment was planned, delivered and monitored in line with current evidence-based guidance, standards, best practice, legislation and technologies.
- Staff ensured that they gave patients enough food and drink to meet their needs and improve their health.
- Staff gave pain relief to patients when required. There was an effective process to ensure patients’ pain relief needs were met and pain was well managed by the service.
- Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
- Staff members were supported to deliver effective care and treatment through recruitment, training and development. There was a clear approach for supporting staff and managers appraised staff member’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
- Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. Patients were supported to make decisions and, where appropriate, their mental capacity was assessed, recorded and acted on in line with relevant legislation.
- Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
- Staff provided emotional support to patients to minimise their distress.
- Staff tried to ensure that patients and those close to them were partners in decisions about their care and treatment.
- The service planned and provided services in a way that met the needs of local people.
- The service took account of patients’ individual needs.
- Patients could access the right care at the right time. Waiting times were minimal and managed in a manner that met patients’ needs.
- The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.
- Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care.
- The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
- Managers promoted a positive culture that supported and valued staff, creating a sense of common purpose, based on shared values.
- The trust used a systematic approach to continually improve the quality of its services.
- The service had effective systems for identifying risks, planning to eliminate or reduce them and coping with both the expected and unexpected.
- The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
- The trust engaged well with staff to plan and manage appropriate services and collaborated with partner organisations effectively.
- There was a positive focus on continuous learning and improvement for all staff. Staff members said they were supported to develop their professional skills and encouraged to shared good practice and identify innovation.
- The therapy service was not provided at the weekend at the time of inspection.
- Therapy staff did not feel they were able to offer rehabilitation as much as they wanted to meet individual patient need.
4 July 2019
We rated it as good because:
- The approach to end of life care was multidisciplinary with both internal and external parties and all worked together to support patients at the end of their lives.
- Care was evidence based and the service benchmarked itself to other external providers to ensure best practice was always maintained.
- End of life care services were planned, organised and delivered well.
- Services were safe and well managed.
- There was 24-hour cover for end of life services and processes in place to support more vulnerable patients and their families.
- Care given was holistic and feedback from patients and their families described excellent care and treatment.
- Patients and their families were truly respected and the nurse’s communication with the patients and their families was excellent. Staff were compassionate and caring and involved patients and their families in decisions about their care and treatment.
- Consideration of privacy and dignity was consistently embedded in everything that the staff did and this was evident in the conversations we had with staff and observations taken on home visits.